title: Overall survival of patients with advanced pancreatic cancer improved with an increase in second-line chemotherapy after gemcitabine-based therapy.
abstract: BACKGROUND
  In the last decade, gemcitabine-based regimen as first-line therapy has demonstrated low efficacy regarding overall survival benefit for patients with advanced pancreatic cancer.
  
  
  OBJECTIVE
  The purpose of this study was to explore a new strategy, such as an increased second-line chemotherapy rate, in order to improve overall survival.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  The data in the literature on gemcitabine-based therapy for patients with advanced pancreatic cancer were collected by searching databases, such as MEDLINE, EMBASE, the Chinese Biomedical Literature Analysis and Retrieval System, and EBM Reviews (Cochrane Database of Systematic Reviews). Linear regression was used to explore the relationship between overall survival and second-line chemotherapy. The primary endpoint was overall survival. The secondary endpoints were progression-free survival and residual survival.
  
  
  RESULTS
  Ten randomized controlled trials, involving 2,679 patients, were included in the present study. The results indicated that overall survival was positively correlated with a combination of chemotherapy, stage of disease and second-line chemotherapy in patients with advanced pancreatic cancer (r = 0.753; P = 0.003). Meanwhile median overall survival would be prolonged about 1.56 days if second-line chemotherapy was increased by 1% (t = 4.33; P = 0.001). Progression-free survival was not significantly correlated with second-line chemotherapy (r = 0.092; P = 0.701); in contrast, residual survival was positively correlated with second-line chemotherapy (r = 0.717; P < 0.001).
  
  
  CONCLUSIONS
  Our study indicated that overall survival closely correlated to second-line chemotherapy in patients with advanced pancreatic cancer; more attention should be paid after first-line therapy which must be administered skillfully in order to improve overall survival, and this is worthy of further study.
authors.affiliation: Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Guangzhou, China.
authors.forename: Yuan Dong
authors.initials: YD
authors.lastname: Zhang
authors.forename: Qiong
authors.initials: Q
authors.lastname: Yang
authors.forename: Zhi Min
authors.initials: ZM
authors.lastname: Jiang
authors.forename: Wen
authors.initials: W
authors.lastname: Ma
authors.forename: Si Wei
authors.initials: SW
authors.lastname: Zhou
authors.forename: De Rong
authors.initials: DR
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000093542:Gemcitabine